Journal of the American Medical Association, Volume 217, Issue 9: Pages 1241-1242, 30 August 1971.
Jack R. Harnes, MD
A recent article, "Whither The Foreskin"1 again questions the value of circumcision, a problem bandied about by physicians for years. It also calls attention to some fanciful titles for medical articles., eg. "Penile Plunder,"2 "The Fate of The Foreskin,"3 and "The Rape of the Phallus,"4 a group I feel justified in joining.
In June 1965, Morgan4 attached circumcision as barbarous (I agree), of no health value (I am shocked), and resulting in decreased sexual pleasure in the male (I am depressed).
I am certain that I was not alone among the circumcised readers of that article in becoming quite concerned. My father was a young physician at the time of my circumcision and presumably had it done with the best of intentions. Nonetheless, although I am not a psychiatrist, a number of questions came to my mind. Did this represent an unconscious attack by my father on my oedipus complex? was he aware of a future decreased pleasure the operation would incur and did this represent hatred of me? Did he, with my mother's consent, subconsciously want me castrated?
What was done, was done. A search through the Index Medicus for the past 40 years revealed that no surgeon had reported developing a plastic procedure to replace the prepuce. In fact I did not even find any reference to any prosthetic device for this purpose. I spoke to several acquaintances in the field of both plastic surgery and plastic manufacturing and in all instances met with what amounted to a cold shoulder ("what are you, some kind of nut or something?"). Obviously, this kind of approach to my problemwould prove fruitless.
Of further concern, was the statement that circumcision no longer guaranteed me freedom from the fear of cancer of the penis. Daily inspection has failed to reveal any growth either on or of the organ, but there still remains an almost constant fear that I may face amputation.
The smug look I noted on a number of my confreres during the period following the publication of Morgan's report did nothing to help my damaged ego. Was Morgan correct? Was I doomed to a life of unfulfilled sexual pleasure? Was the blissful sensation I had enjoyed merely a sham, a figment of my imagination? Obviously here was a problem that warranted the scientific investigation not cited in any reference by Morgan.
I must report at the onset that my investigations were fruitless in solving the question. However, in the hope of preventing other investigators from pursuing similar approaches to the problem, I feel that publication of my failure is indicated.
Method.- The first and obvious approach was to interview males who had been circumcised as adults. Letters were written to all board certified urologist in New York City explaining the nature of my investigation, providing of course, that the urologist had no objection to my interviewing his patients. The results of this inquiry are listed as follows:
Sent 135 Replies 29 (22%) (1) Lost to follow-up 27 (93%)* (2) "What are you, some kind of nut or something?" 24 (83%) *Unfortunately, the two patients apparently not lost to follow-up belonged to physicians listed in reply 2.
The next approach attempted was to interview my own patients. The question as to when the men had been circumcised seemed to produce no problem but unfortunately the two men I discovered during the course of one year who were suitable for study were uncooperative during the interview and have been lost to follow-up. It is of course of some interest that during that year I noticed a gradual increase in the percentage of women patients, who now constitute 80% of my practice. The remaining 20% are men who have certain psychological problems which would make them unsuitable for the study. (I have recently noticed an increase in this type of male patient in my practice.)
Then I encountered a 55-year-old stock analyst who had been circumcised for phimosis at age 20 years. He had had sexual surgery intercourse prior to the surgery. In retrospect (35 years in retrospect to be exact), the patient recalled that the two or three episodes of sexual intercourse he had prior to circumcision now seem to have been more pleasurable than subsequent episodes. It is perhaps pertinent to the evaluation of this sole bit of significant datum in the study to point out that immediately after spontaneously recounting this case history the subject launched into an enthusiastic discussion of his current hobby, bird watching, extolling the beauty of the female cow bird.
It was apparent at this time that I would be unable to secure first-hand (or should I say second-hand?) facts for my study and that I must secure what is virtually hearsay information. However, it seemed reasonable to assume that women who may have had intercourse with circumcised and uncircumcised men might have noted some indication of difference inthe men's pleasure.
I first raised the question with my wife and office nurse. (Incidentally, readers requesting reprints of this article should note my new address.) Unfortunately, neither of these resources proved fruitful. However, I have learned that male nurses work well in an office situation, a point I do not believe is generally known.
I next enlisted the support of an acquaintance on the vice squad of the New York Police Department. (Although I explained the scientific nature of this report, he had preferred to remain anonymous, citing the necessarily confidential nature of his work.) With his assistance I was able to interview 15 experienced prostitutes form all walk of life. Their replies were as follows:
Interviewed 15 Replies 15 (100%) "Whataya, some kind of nut or som't'in" 14 ( 93%) None (Did not speak English or French) 1 ( 7%)
Summary and Conclusion.- An attempt was made to ascertain the validity of the statement that circumcised men find sexual intercourse with women less pleasurable than do uncircumcised men. Various approaches to the question are enumerated. Unfortunately, the question remains unanswered. However in view of the emotional trauma this question has produced since being raised by Morgan, further investigation is warranted.
Dr. Harnes' very valid question, which could not be answered in 1971, has now been answered. For more information see "The Case Against Circumcision" by John P Warren, FRCP and Jim Bigelow, Ph. D. and also "The prepuce: specialized mucosa of the penis and its loss to circumcision." By John R. Taylor, MB et al.
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